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This week, Wil responds to a scared mom's concerns about her teen daughter's mutliple health conditions on top of diabetes. It's a delicate conversation and Wil does what he can to help assure this mom that all will be OK.

Anne, D-Mom from North Carolina, writes: Hi Wil, my T1 daughter is 14, in ninth grade, and was diagnosed at 12. She also has dyslexia, ADHD
and anxiety, caught early by amazing teachers. Rounding out the labels, she
also found out she has celiac disease when she was diagnosed with diabetes and,
as she always wanted to be a pastry chef, her celiac was the insult on top of
the injury.

She
is a great person, warm, kind and super smart. And she is struggling. Her
diabetes and celiac self-management are amazing but her results are not. Her
numbers have been crazy, to say the least. As you know, hyperglycemia makes it
almost impossible for someone with learning disabilities to function in school.
She has missed a ton of school but works hard to keep her honors.

She
is so strong but I am afraid the next step is total burnout. All she does is
make up work or deal with the disappointment of missing yet another test or
quiz because of her BG. I just found your column and get the feeling you would
have good ideas for my sweet girl.

Oh,
but on the plus side, she has taken up fencing and is the only girl on the high
school team. She seems to have an uncanny ability to jab other people with a
sharp object before they jab her, and she wants to be a state champ if we could
get her feeling better. (I would strongly suggest fencing to any diabetic --
catharsis out the wazoo.)

Wil@Ask
D’Mine answers: Hold on a second, Anne, I’m Googling
to see if there is a Fencing Academy anywhere near me. I’m all about catharsis
and can’t believe I never thought of fencing before. Let’s see here: Barbed
wire fences, wildlife fences, fences and gates, chain-link fences, picket
fences, electric fences… Damn! No fencing with swords to be found. Now I really
need some catharsis for my frustration in not finding a Fencing School! But in
the meantime, I think we can all agree we need an all-diabetic fencing team for
the Summer Olympics next time around. That should be our first Olympic Team
once we get nation-hood. I bet we could mop up the floor with the competition!

But your poor kid! She has a lot on her plate. And I think you are correct to worry about
burnout, or, as you termed it: Total Burnout.

For what it’s worth, I’ve noticed one interesting thing over
the years that I really want you to know: Without exception, type 1s are the
strongest people I know. I don’t know if, like steel forged in fire, the
disease makes us so, or if the mysterious tangled DNA that gives us our crappy
immune systems that wipe out our beta cells also grants us stronger
personalities. But either way—trust me on this—your warm, kind, super smart offspring
has a soul stronger than a diamond.

Of course, that doesn’t make her immune from burnout, total
or otherwise.

So let’s talk about burnout. Diabetes burnout tends to
happen when the level of effort put forward does not produce the expected benefits.
Or in plain English, you find yourself working your ass off for no reward. As
she tries hard and still fails, she’s ripe for burnout.

All people with diabetes are susceptible to this, we T1s are
especially so. Think about it. If you have type 1 you have to pay attention to everything
in your universe. Things most people do without thinking, like eating and
moving, require pre-planning for us. Things that have no impact on most people
can kill us, like minor illnesses, lapses in judgment (a math error on your
insulin can do it), or even a big snowstorm that blocks the road to the pharmacy
at a bad moment.

On top of that, our diabetes is unrelenting, 24-7-365.
Diabetes, like the diamonds that make up our souls, is forever.

But here’s a darker secret: Even if her efforts at control
succeeded, she’d still be at risk for burnout. Why? Because there’s no real
reward in the traditional sense. Success in diabetes means being able to feel
like “normal” people do. Or, as my good friend Bill
Polonsky likes to say, the reward for all our hard work in diabetes
is that, “Nothing bad happens.”

Given all of that, it’s hard not to burn out. Hell, I’m
getting burned out just thinking about it and writing about it.

So what to do? How do we cure burnout? Well, like the flu,
hepatitis B, meningitis, and tetanus, the best “cure” for burnout is not to get
burned out in the first place. So like flu, hepatitis B, meningitis, and
tetanus, it’s a good idea to get a burnout vaccine to prevent it.

Really? There’s a shot for that? Sure.

Well, sort of. The best vaccination to prevent burnout is a
change of pace, a vacation, if you will. So how do you take vacation from diabetes?
Well, for type 2s on orals, sometimes just not checking blood sugar for a week
or two will do the trick. Of course, that’s not an option for type 1s.
Likewise, you can’t take a pastry vacation if you have celiac; nor is it
realistic that she could just light an aroma therapy candle and take a break
from her anxiety, or just pay more attention to avoid that ADHD.

But while she can’t safely take a break from all her health
challenges, she could take a break from the other challenges in her life to
take a load off of her soul. For instance, she could take a vacation from schoolwork.

If she were a couple of years older, I’d make the radical
suggestion that she give up on school and all its added stresses, just take the
GED test to complete high school early, and then take a year off to re-charge her batteries. During that year she
could focus all her available attention on diabetes control without the other
stresses and distractions, and then get on with life (defined by me in this day
and age as getting a college degree). But I think she’s too young for that
prescription.

You say the teachers at her school are amazing. What about
the administrators? Are they equally amazing? I’m wondering if a scheduled respite
routine might help your kiddo. I guess what I’m envisioning is a way for her to
leap-frog ahead of her schoolwork rather than always playing catch up.

Maybe she could attend school four days a week instead of
five. Or maybe Tuesday and Thursdays could be half days. Or maybe she could
take off one full week a month -- something that could give her a predictable
island of sanity where there are fewer things to focus on at once. Not only
could this help her keep her head above water, it would give her something to
grab onto when things starting getting to be too much. OK, it sucks right now, but in three days I’ll be on my sunny little
island with less to worry about…

So those are my ideas for your sweet girl. I hope you find
them good. For the rest of you suffering burnout, total or merely eclipsing, here
are some other vaccines you can try:

* Celebrate little victories. OK, so that last A1C
was an epic disaster and the endo, in a misguided attempt to motivate you, made
you cry by telling you that you are going to go blind. But, you bolused the
hell out of the tiramisu at the Olive Garden, flat lining your blood sugar. Let
the big one go and pat yourself on the back for the little job well done.

* Limit priorities. A good way to avoid burnout is not to put
too much on your plate at once. Blood sugar too high? Blood pressure too high?
Cholesterol too high? Weight too high? No wonder your stress is too high! Maybe
the weight loss can wait until some of the other numbers look a little better.

* Get a DBF. No, not a Data Base File or a Divorced Black
Female. I’m talking about a Diabetes Best Friend. OK, well, come to think of it,
there’s no reason at all why your DBF can’t be a Divorced Black Female. Look, sometimes
the best medicine is just sharing your burdens with another human being, and
who more qualified than someone who not only understands, but also walks in
your same shoes? Hey, and once you and your DBF vaccinate each other for
burnout, you can take fencing lessons together.

Because we need to get ready for the Olympics.

Disclaimer: This is not a medical
advice column. We are PWDs freely and openly sharing the wisdom of our
collected experiences — our been-there-done-that knowledge from the
trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear
trees. Bottom line: we are only a small part of your total
prescription. You still need the professional advice, treatment, and
care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more
details click
here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
For more information about Healthline's partnership with Diabetes Mine, please click here.

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